HospitalInspections.org

Based on observations, staff interview, and policy review, the Critical Access Hospital (CAH) failed to ensure all supplies are maintained to safely meet patients' needs for both day-to-day operations and during emergencies in one of three Emergency Departments (ED) Crash Carts, one of one ED EKG cart, two of two Emergency Rooms (room 1 and 2) and one of one Physical Therapy room cabinet. This deficient practice or the failure of the facility to dispose of expired supplies placed all patients at risk for receiving ineffective supplies.

Findings include:

- Emergency Room 2 Emergency Crash Cart observed on 3/6/2017 at 11:45 AM revealed the following outdated supplies:
1) Six Tongue Depressors with expiration dates of 1/2014.

Registered Nurse, Director of Nursing (DON), Staff A interviewed on 3/6/2017 at 12:00 PM acknowledged the supplies were outdated and should have been disposed.


- Emergency Room 1 EKG (electrocardiogram-records heart electrical impulses to determine the rate and regularity of heartbeats) cart observed on 3/6/2017 at 11:35AM revealed the following outdated supplies:
1) Two Nuprep gel tubes (lubricate to help pick up the electrical impulses) 4 ounces with expiration dates of 1/2006 and 8/2005.
2) One Surgitube (lubricate) sterile tube opened and used.
Registered Nurse Staff B interviewed on 3/6/2017 at 11:40 AM acknowledged the supplies were outdated/opened and should have been disposed.

Registered Nurse Assistant Director of Nursing (ADON) Staff F interviewed on 3/6/2017 at 11:40 AM acknowledged the supplies were outdated and should have been disposed.


- Emergency Room 2 cabinet observed on 3/6/2017 at 11:55 AM revealed the following outdated supplies:
1) Thirty-five Shave biopsy blades with expiration dates of 11/2015.
2) One Alcohol swab stick with expiration date of 2/2017.
3) Three BactiSwabs (swabs to disinfectant skin) with expiration dates of 2/20/2017 and 3/5/2017.

- Emergency Room 2 second cabinet observed on 3/7/2017 at 8:00 AM revealed the following outdated supply:
1) Insyte (Intravenous plastic needle to place in vein) 14g x 1.75" with expiration date of 1/2017.

Registered Nurse, DON, Staff A interviewed on 3/6/2017 at 12:00 PM acknowledged the supplies were outdated and should have been disposed.

Registered Nurse Staff B interviewed on 3/6/2017 at 11:40 AM acknowledged the supplies were outdated and should have been disposed.


- Physical Therapy room cabinet observed on 3/7/2017 at 10:30 AM revealed the following outdated supply:
1) Bio Freeze (helps relieve muscle pain) 4 ounce tube with expiration date of 7/2016.

Physical Therapist Aide Staff D interviewed on 3/7/2017 at 10:30 AM acknowledged the Bio Freeze was outdated and should have been disposed.


Policy titled "Medical Supply Outdates" reviewed on 3/7/2017 directed staff " ...If supply is outdated, dispose of properly and re-order item ..."

Based on observation, staff interview and policy review the Critical Access Hospital (CAH) failed to ensure outdated, unusable medications were removed and made unavailable for patient use in one of three Emergency Crash Carts (Emergency Room 2). This deficient practice to ensure that outdated medications are removed placed all patients at risk for receiving ineffective medications.


Findings Include:

- Emergency Room 2 Emergency Crash Cart observed on 3/3/2017 at 11:45 AM revealed the following outdated medications:

1) Three Sodium Chloride 0.9 % 10ml (milliliter) syringes with expiration dates of 12/2016.
2) Two vials of Calcium Gluconate (a medication-injected into a vein to treat low blood calcium, high blood potassium and magnesium toxicity) 10 ml with expiration dates of 2/2017.

Registered Nurse, Director of Nursing (DON), Staff A interviewed on 3/6/2017 at 12:00 PM acknowledged the medications were outdated and should have been disposed.


Policy titled "Outdated Drugs" reviewed on 3/7/2017 directed staff " ...The pharmacy will remove all outdated or unusable drugs from all areas of the hospital on a monthly basis. In order to prevent their being administered, all outdated and unusable medications will be returned to the pharmacy for their disposal or storage until they can be returned through proper channels ..."